[Bladder stones and lithotomy: a vanished ailment as the basis of urology]

Urinary bladder stones have played a role in medicine for ages. Many examples of this disease can be found in Dutch history. The need to cure this ailment led to the development of extremely painful interventions, for which self-appointed specialists very soon came forward and were then employed in this capacity in the cities. The various interventions were: perineal lithotomy using either the 'apparatus minor' or the 'apparatus major', lateral lithotomy, cutting for stone 'in two trips', suprapubic cystotomy, and ultimately lithotripsy. Bladder stones have largely disappeared from contemporary medicine and now represent only 5% of all urinary-tract stones, the main groups at risk being men with prostate hypertrophy, whether or not surgically treated, and women previously operated on for incontinence. Bladder stones are now seen mainly in developing countries. The dangerous operations via an extravesicular route have now been replaced by transurethral procedures in which the stone is disintegrated with the aid of an electric charge, shock waves or ultrasound. In an early stage, this ailment was the incentive for the development of a separate medical specialty: urology.